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1/227. Childhood lipoma arborescens presenting as bilateral suprapatellar masses.

    Synovial lipomatous proliferations are uncommon idiopathic lesions. Suprapatellar synovial plicae commonly are diagnosed with mechanical knee problems. However, it is not widely known that these plicae can isolate the suprapatellar pouch from the rest of the knee joint. We describe a case of complete bilateral compartmentalization of the suprapatellar pouch (plica synovialis suprapatellaris) in which a 10-year-old boy developed articular tumors isolated in this area. Arthroscopic synovectomy specimens revealed the lesions to represent lipoma arborescens. Rheumatologists should be aware of these two findings when examining a child with swollen knee. ( info)

2/227. Pigmented villonodular synovitis of the elbow: a case report and literature review.

    Pigmented villonodular synovitis is a well-described, benign proliferative disorder of the synovium that rarely affects the elbow joint. Only 12 cases have been reported in this site. A case is presented of elbow involvement by pigmented villonodular synovitis that was documented by magnetic resonance imaging before surgery and monitored until recurrence. ( info)

3/227. Pedal giant cell tumor of tendon sheath.

    The authors present a brief review of giant cell tumor of tendon sheath and three case reports. A discussion emphasizing the histologic characteristics of this lesion demonstrates the benign-to-malignant variability of these neoplastic growths. Special attention is directed to a case with aggressive histologic characteristics. Reexcision after surgery should be considered in cases where microscopic examination reveals a lesion with characteristics suggestive of potentially aggressive behavior. ( info)

4/227. Laterosubungual giant cell tumor of the tendon sheath: an unusual location.

    Giant cell tumor of the tendon sheath is the second most frequent nonepithelial benign tumor of the hand after ganglion cyst. Although it is recognized as a condition that may involve the distal digit, there has been only 1 report of periungual involvement. We describe a second case at that site in this article. ( info)

5/227. Pigmented villonodular synovitis of the shoulder: review and case report.

    Pigmented villonodular synovitis (PVNS) as reviewed in detail elsewhere most frequently involves the knee and finger synovial structures; shoulder involvement is rare: A search through the English literature yielded 18 publications describing 25 cases of PVNS affecting the shoulder joint. Analyzing these reports we found the clinical and radiological findings generally to be nonspecific, often mimicking a malignancy, as in the case presented here of a 16-year-old boy with painful swelling in the area of the left proximal humerus. magnetic resonance imaging showed a suspected malignant soft tissue mass involving the shoulder capsule and measuring 7.5 x 6 x 4 cm. Preoperatively the patient could recall no trauma; however, postoperatively he did report a distortion trauma of the affected shoulder following a bicycle accident. Intraoperatively, two tumors were found infiltrating the axillary vessels and nerve and tendon structures originating in the capsule of the shoulder joint. Rapid sections of the tissue revealed no signs of malignancy; further pathohistological examination revealed localized PVNS. Preoperatively, the shoulder joint was not suspected as the primary site of origin of the tumor because the patient had no complaints or functional deficits of the shoulder. The clinical presentation of such a PVNS lesion over the proximal humerus is unusual and to date has only twice been described in the literature. ( info)

6/227. Extraarticular villonodular synovitis of the tendoachilles: a case report.

    Extraarticular form of pigmented villonodular synovitis is rare and usually presents as an extension of a primary intraarticular process. Purely extraarticular lesions are even less common. Pigmented villonodular synovitis involving the synovium around the tendoachilles has not been reported. We report a unique case in a healthy 22-year-old male who presented with a swelling around the tendoachilles for a year. It became painful following a traumatic event 4 weeks prior to consultation. magnetic resonance imaging (MRI) revealed an extraarticular soft tissue mass moulded to the posterior surface of the calcaneum. It was excised and histology revealed pigmented villonodular synovitis. ( info)

7/227. Pigmented villonodular synovitis of the knee presenting as a popliteal cyst.

    Pigmented villonodular synovitis is a locally aggressive tumor of the synovium of joints and tendon sheaths. It is commonly seen in the synovial lining of the flexor tendons of the hand and in the synovium of the knee and less commonly in other joints. A case of pigmented villonodular synovitis of the knee in a 60-year-old man, with an intra-articular origin extending extra-articularly, is presented. The interesting point is that the initial diagnosis was a Baker cyst. ( info)

8/227. Open synovectomy with cryosurgical adjuvant for treatment of diffuse pigmented villonodular synovitis of the knee.

    Pigmented villonodular synovitis (PVNS) is an uncommon, benign disorder usually affecting the synovial membrane of large joints. The diffuse form of PVNS is extremely difficult to control, and long-term recurrence inevitably results in arthrodesis or arthroplasty. Current treatments include surgical, chemical, and radiation synovectomy, but all have significant failure rates. In hope of obtaining a more complete synovectomy, we used cryosurgery as an adjuvant to open synovectomy in three patients. Two patients presented with multiple failed arthroscopic synovectomies, and one patient presented with arthroscopically unresectable PVNS. The surgical approach involved take down and repair of the anterior meniscal attachments, and direct entry into the posterior space through medial and lateral femoral capsular attachments. Cryosurgical surface spray was used on all non-cartilaginous surfaces. At follow-up of 14, 30, and 31 months, all three patients remained symptom-free and there were no indications of clinical recurrence. There were no obvious complications or morbidity from the cryosurgical procedure and all patients had excellent functional recovery. All patients returned to sports and their jobs without restrictions. In the past, it has been shown that cryosurgery is a safe and effective treatment modality for proliferative joint disease. We propose the use of adjuvant cryosurgery for PVNS patients selected for open synovectomy. ( info)

9/227. Pigmented villonodular synovitis of the temporomandibular joint: a case report.

    The eighth known case of pigmented villonodular synovitis of the temporomandibular joint is presented. Pigmented villonodular synovitis is a benign but locally destructive lesion of obscure cause. In the temporomandibular joint, this lesion is characterized by the insidious onset of a mildly symptomatic preauricular mass. The treatment of choice is complete excision. ( info)

10/227. Pigmented villonodular synovitis secondary to laceration of the perforating branch of the peroneal artery.

    A case of peroneal artery injury subsequently developed into a lesion resembling an extra-articular tenosynovial giant cell tumor, which is a type of pigmented villonodular synovitis (PVNS). This case supports the hypothesis that accident trauma, such as a vascular injury, can be the etiology of PVNS. ( info)
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